Hospitals in disadvantaged areas lag in telehealth, HIE adoption

Though the adoption of telehealth and health information exchange, or HIE, functionalities has increased over time, hospitals in more socioeconomically disadvantaged areas are still less likely to adopt these technologies than their counterparts, recent research reveals.

Published in JAMA Health Forum, the study examined whether the adoption of four hospital-based HIT functionalities varied by hospital service area (HSA) socioeconomic deprivation. The functionalities were: treatment-stage telehealth, post-discharge telehealth services, electronic data query capability and electronic data availability.

The study conducted by researchers at the University of Maryland and Regenstrief Institute links data from the 2018-2023 American Hospital Association (AHA) Annual Survey and Information Technology Survey with the 2021 HSA-level area deprivation index. They included acute care hospitals with complete data on HIT outcomes. The data comprised 16,646 observations for the telehealth outcomes and 9,218 observations for the HIE outcomes from 2018 to 2023.

The researchers found that telehealth and HIE adoption increased across all measures and deprivation levels across the study period, although telehealth adoption appeared to plateau after the COVID-19 pandemic.

However, hospitals in the most socioeconomically deprived HSAs were significantly less likely to adopt all four HIT functionalities compared with those in the least deprived areas. Notably, adoption rates were higher for HIE infrastructure compared to telehealth.

Additionally, accountable care organization participation emerged as a strong predictor of HIT adoption, with higher odds of adoption among facilities participating in ACOs.

"To promote equitable access to digital health tools, policy efforts should focus on addressing socioeconomic barriers and expanding ACO participation in disadvantaged communities, creating the conditions necessary for broader, more equitable HIT adoption," the researchers concluded.

The research highlights the longstanding challenges that socioeconomically disadvantaged areas face in accessing health IT capabilities.

For instance, these areas typically lack access to broadband internet, significantly limiting their ability to utilize telehealth services. A study published in 2023 revealed that U.S. counties with the most significant broadband availability had 47% higher telehealth utilization than those with the least.

Similarly, the health data interoperability at the heart of HIE efforts remains a challenge, particularly for rural healthcare organizations.

Moreover, overarching challenges to electronic health information exchange also hinder telehealth adoption. Research published in 2024 reveals that, despite the significant increase in telehealth use during the COVID-19 public health emergency, adoption was not uniform across hospitals.

The study, which leveraged data from the AHA's annual surveys from 2017 to 2021 and the 2022 AHA IT Supplement Survey, found that larger, nonprofit, and teaching hospitals were more likely to adopt telehealth than their counterparts. Most hospitals (85%) also cited barriers related to vendor interoperability that curbed their ability to exchange health information electronically. The researchers noted that this health information exchange is necessary to fully realize the benefits of telehealth.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.